Explaining Adherence to Supplemental Oxygen Therapy

OBJECTIVES: To describe and explain the patterns of adherence to supplemental oxygen in individuals with hypoxemic chronic obstructive pulmonary disease (COPD). DESIGN: Qualitative study of a case‐series of patients with COPD who use supplemental oxygen. SETTING: Denver, Colorado. PARTICIPANTS: Community‐dwelling, English speaking individuals with hypoxemic COPD receiving long‐term supplemental oxygen therapy. MEASUREMENTS: Forced expiratory lung volume, in liters at one second (FEV1), the St. George's Respiratory Questionnaire, Brief Symptom Inventory, semistructured investigator‐administered interviews. RESULTS: Respondents from a demographically representative sample with moderate to severe COPD (average age, 69; average FEV1, 1.1) described 3 distinct patterns of adherence to supplemental oxygen therapy: as‐needed use, part‐time use, and full‐time use. For many individuals, the pattern of adherence changed with time and reflected their struggle to optimally manage their health, symptoms, physical function, and social milieu. Adherence to oxygen tended to increase with time and was often associated with significant personal compromises. CONCLUSION: Adhering to oxygen therapy is a complex and difficult task with many barriers, including the physical difficulty of using the oxygen, self‐consciousness and a sense of social stigma, lack of perceived benefit, and fear of deleterious side effects from treatment. Improving adherence may involve understanding the process of adapting to oxygen use and addressing the many barriers to therapy.